T&O

Question 1

Gustillo’s classification of open fractures

Answer 1

1 wound <1cm
2 wound >1cm with minimal soft tissue damage
3 extensive soft tissue damage
3a adequate coverage
3b inadequate coverage
3c neurovascular compromise

Question 2

Most dangerous complication of open fracture

Answer 2

Clostridium perfringes - wound infection leading to gas gangrene, shock, renal failure

Question 3

Rx of clostridium perfringes infection

Answer 3

Debride
Abx - benpen + clindamycin

Question 4

Immediate, early and late complications of fractures

Answer 4

Immediate - neurovascular compromise
Early - infection, compartment syndrome, fat embolism
Late - malunion, AVN, post traumatic OA, complex regional pain syndromes

Question 5

What palsy can result from anterior shoulder dislocation and signs

Answer 5

Axillary nerve damage
Regimental patch numbness
Impaired abduction

Question 6

Palsy as a result of a humeral shaft fracture and signs

Answer 6

Radial nerve - wrist drop (unopposed flexion), sensory loss to dorsal surface of lateral 3 and a half digits

Question 7

which fractures are most commonly associated with compartment syndrome

Answer 7

tibial fractures
supracondylar fractures

Question 8

displacement of the lateral and medial fragments in a clavicular fracture and why

Answer 8

medial fragment displaces superiorly bc of SCM pulling and lateral goes inferior with the weight of the arm

Question 9

1 which 3rd of the clavicle is most commonly fractured
2 Which 3rd of the clavicle if fractured is most unstable

Answer 9

1middle third
2 lateral third

Question 10

Which nerves are at risk in a clavicular fracture

Answer 10

brachial plexus

Question 11

Rx of a clavicular fracture. How long to heal

Answer 11

medical - sling immobilisation, analgesia, physio.
Surgery

4-6 week healing time

Question 12

Risk factors for fracture non union or malunion

Answer 12

comminuted
displaced
older people
smoker
overweight

Question 13

RF for rotator cuff tears

Answer 13

older
repetitive overhead shoulder motions
overuse
DM
Smokers
Trauma

Question 14

What muscles make up the rotator cuffs

Answer 14

Supraspinatous
Infraspinatous
Subscapularis
Teres minor

Question 15

Examination findings in rotator cuff tears

Answer 15

Unable to do empty can test - (supraspinatous)
Pain on resistance when externally rotate arm 90 degrees (infraspinatous)
Tenderness

Question 16

what is adhesive capsulitis and risk factors for it

Answer 16

Frozen shoulder. inflammation of joint causing thickening, fibrosis and adherence of capsule

DM
Thyroid

Question 17

examination findings in adhesive capsulitis

Answer 17

symmetric loss of active and passive ROM
pain throughout movement
Might get stuck with pain radiating down biceps

Question 18

Blood investigations that might be done for adhesive capsulitis. Think associated conditions

Answer 18

HbA1C
TSH

Question 19

Rx of adhesive capsulitis

Answer 19

PT, NSAIDs, Intra articular steroid injections

Surgery if doesn’t help

Question 20

Who is subacromial impingement common in
Sx
What is the treatment

Answer 20

U25s - active individuals or in manual labour
Pain anterolaterally
Conservative +/- steroid injections

Question 21

RF for humeral shaft fractures

Answer 21

High energy trauma
Osteoporosis and older age
Smoking

Question 22

Main complication to be aware of for humeral fracture and the sx/signs of this

Answer 22

Radial nerve injury
- Weakness in wrist extension
- reduced sensation of dorsal 1st webspace

Typically no loss of elbow extension as this part of the nerve comes off before the radial groove

Question 23

Cause of an anterior shoulder dislocation ie what position is the arm in when force is applied

Answer 23

extended, abducted and externally rotated humerus

Question 24

What usually causes a posterior shoulder dislocation

Answer 24

seizures or electrocution

Question 25

Which nerves may become compromised in shoulder dislocations

Answer 25

axillary suprascapular

Question 26

Other injuries that may be concurrent with a shoulder dislocation

Answer 26

Hill sachs - impaction on humeral head Bankarts - impaction on glenoid Rotator cuff injuries

Question 27

What sign on X-ray indicates a posterior dislocation. And which view is this visible in

Answer 27

light bulb sign Y view

Question 28

what is a common cause of b/l carpal tunnel syndrome

Answer 28

RA

Question 29

Surgical rx of NOFs: Extracapsular (subtrochanteric and intertrochanteric) Intracapsular (displaced and undisplaced)

Answer 29

Extracapsular subtrochanteric - inter medullary nail Extracapsular intertrochanteric - DHS Intracapsular displaced - Total or semi arthroplasty. Total preferred if person independent and fit Intracapsular undisplaced - internal fixation

Question 30

Examination sign of a NOF

Answer 30

Externally rotated shortened leg

Question 31

SALTER Harris classification of pads fractures

Answer 31

1 Straight - through the physics only 2 Above - through physics and metaphysics 3 Lower - through physics and epiphysis 4 Through - physis, epiphysis and metaphysis 5 ER - Erasure or cRush injury

Question 32

OA vs RA on xray

Answer 32

OA - LOSS loss of joint space osteophytes subchondral sclerosis subchondral cysts RA LESS Loss of joint space Erosions Subluxation Soft bones (osteopenia)

Question 33

imaging modality of choice for osteomyelitis

Answer 33

MRI

Question 34

what movements of the wrist is medial epicondylitis (golfers elbow) exacerbated by

Answer 34

wrist flexion and pronation

Question 35

what meds are first line for lower back pain

Answer 35

NSAIDs

Question 36

signs of compartment syndrome

Answer 36

parasthesia pain - worse when doing passive movements trauma to the limb normal x ray findings

Question 37

imaging for supraspinatous tendinitis

Answer 37

none - clinical diagnosis

Question 38

imaging choice for suspected c spine fracture

Answer 38

ct neck

Question 39

how long is abx course for septic arthritis usually

Answer 39

2 weeks IV followed by another 4 weeks oral Tends to be fluclox or clindamycin if pen allergy

Question 40

kocher criteria for septic arthritis

Answer 40

unable to weightbear raised ESR raised WCC fever >38.5

Question 41

most common organism causing septic arthritis in adults and in children

Answer 41

staph aureus haem influenzae in children

Question 42

most common organism causing septic arthritis in adults and in children

Answer 42

staph aureus haem influenzae in children

Question 43

causes of septic arthritis

Answer 43

haematogonous spread - accesses, wounds disseminated infection eg gonorrhoea direct - joint injections, joint surgery, penetrating injuries

Question 44

rf for septic arthritis

Answer 44

RA, SLE, prosthetic joints, IVDU, diabetes, immunosuppression

Question 45

why are people with RA/SLE more at risk of septic arthritis (pathophys)

Answer 45

inflammation - neovascularisation - bacteria spread from distant sites - reduced joint defence leads to rapid colonisation

Question 46

synovial fluid appearance in septic arthritis

Answer 46

yellow/green, turbid

Question 47

complications of septic arthritis

Answer 47

joint damage osteomyelitis sepsis

Question 48

Ix of choice for osteomyelitis

Answer 48

MRI

Question 49

commonest causes of rotator cuff tears

Answer 49

chronic overuse acute trauma degeneration

Question 50

presentation of subacromial impingement syndrome what group of people

Answer 50

<25 - active anterior shoulder pain, painful at 60-120 degrees worse at night and at rest

Question 51

presentation of rotator cuff tears what group of people

Answer 51

40-70 yrs lateral pain, particularly over greater tubercle Can not lift arm above 90 degrees

Question 52

what examination tests - supraspinatous - infraspinatous - subscapularis

Answer 52

s - empty can test i - weakness or pain on resisted external rotation su - weakness when lifting hand against resistance from small of back

Question 53

ix that can be done for rotator issues, when would they be done

Answer 53

USS or MRI - if other treatment hasn't worked first

Question 54

ddx of rotator cuff tear

Answer 54

SAIS, adhesive capsulitis, inflammatory arthritis, acromioclavicular OA